An Interview with Dr. Stephen Farra
I interviewed a colleague who helped develop the Psychology Program at Columbia International University, Steve Farra. Steve has extensive practical experience in counseling and psychotherapy, as well as top-notch academic credentials. (See his bio at the end of the interview.) He will help you better understand the nature of and treatments for depression. Here are questions I asked him, and his responses.
What are the most common forms of depression?
It is important to distinguish between temporary distress (from life events), and true depression (which is more an on-going state of mind/brain, and is typically longer lasting and more severe). There are several sub-categories of true depression, including forms that are primarily psychological/cognitive in nature (produced by relentless toxic or negative self-talk), and full major depression that involves imbalances and shortages of neurotransmitters in the brain–primarily serotonin, dopamine, and norepinephrine. Full-blown major depression can appear with or without “delusions” in the form of grossly distorted and false beliefs.
What is the difference between depression spawned by a loss (unemployment, death of a loved one) and ongoing, recurring bouts of serious depression?
Grief is not depression, but great loss can lead to true depression over time. This is why it is important that individuals do their “grief work” (taking time, over time to express one’s sorrow, hurt, and to shed many tears after a deep emotional loss). If individuals do their “grief-work” for several months after a great loss, often real, recurring depression can be avoided.
What medical illnesses or conditions can spawn depression? Would you recommend a thorough medical checkup early in the process for someone depressed who wants help?
It is often valuable to obtain a complete physical exam, including a full electronic blood panel or profile. Any medical condition that appears in the blood panel/profile and puts stress on a person’s system for a long period of time can significantly drain the serotonin, norepinephrine, and dopamine in the neural network of the brain, contributing to a major depressive episode. Additionally, there are certain physiological problems like hypothyroidism (lower than normal thyroid functioning) which can so lower one’s metabolism and internal energy that he or she feels “down” (“depressed”) much of the time. Besides good psychological care, expert medical testing and care is needed in cases such as these.
What’s the basic difference between a Psychiatrist and a Psychologist? If a person has never been to a professional for help, which should he see first? Why?
A Psychiatrist is a medical doctor, who specializes in mental health care. A Psychologist is someone who is an expert in testing and diagnosis, as well as various forms of psychotherapy. Both individuals typically have legitimate doctorates from large, state universities, and have worked under other experts for their residencies and internships for years prior to being granted their own licenses for independent practice.
Often it is useful for an individual to see a Psychologist first for testing, diagnosis, and treatment planning before seeing a Psychiatrist for psychotropic* medications, “med checks,” and “mental status exams.” You can usually afford and get more time to discuss important life issues with a Psychologist (whose time is usually less expensive than the hourly rate charged by a Psychiatrist).
I employed the treatment term “psychotherapy” a moment ago. Many folks use the word interchangeably with “counseling,” but there’s an important difference. Counseling is helping relatively healthy, normal people make positive adjustments in their their lives and relationships. The broad purpose is to enhance the quality of their lives.
Psychotherapy is more intensive and reconstructive in nature. It usually involves in-depth restructuring of emotions and thought patterns, and it’s often paired with medical treatments for more severe disorders. Typically, psychotherapy takes longer that adjustment counseling.
*I also used the term psychotropic medications earlier in my response to this question. Psychotropic medications are those medications that substantially influence our emotions, moods, and thought patterns.
How does a counselor decide whether a client needs medical intervention?
When any counselor sees severe sleep and appetite disturbance in the life of the client/patient, along with a loss of enjoyment of normally pleasant things, plus a lack of energy for normal socializing (particularly over a matter of weeks), that is a sign that this is not simple distress from life events, but more likely, the onset of a major depression. The individual will then need expert testing, diagnosis, and treatment planning, as well as an evaluation from a medical doctor for psychotropic medications and medication monitoring.
In layman’s language, how does an anti-depressant work? What is the success rate of these medications?
Most modern antidepressants are SSRIs (Selective Serotonin Reuptake Inhibitors) or SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors). They work by increasing the availability of serotonin and/or norepinephrine in the synaptic cleft (the very small space between nerve cells in our brain’s neural network). They increase this availability by inhibiting the normal re-uptake mechanism in the cells (since less is pulled back up into the cell, more remains in the synaptic cleft).
The herbal supplement St. John’s Wort is also sometimes used for mild to moderate depression. This herb apparently stimulates the nerve cells to generate/produce more serotonin, so more is released into the synaptic cleft.
There is an intense, on-going debate that is currently underway in the mental health fields as to the actual effectiveness of anti-depressants, both short-term and long-term. As someone who regularly reads outcome studies, the best sense I can make out it is as follows: Somewhere between one half and two thirds of those taking the anti-depressant meds appear to get some short-term benefit from them. But, if the gains are going to last, those short term gains must be combined with the benefits of effective psychotherapy and life-style change (such as regular exercise and regular, positive social interaction). To just give a person a prescription without concurrent psychotherapy and lifestyle review and restructuring is now generally considered to be “bad” (ineffective) medical practice.
Other than a genetic predisposition or low levels of certain brain chemicals, what are other major causes of depression?
There are genetic predispositions to depression, clinical anxiety and several other mental disorders that can be seen clearly running through some family trees (not every person, but some/several individuals in each generation). Besides these genetically–based conditions, a chronic lack of exercise, the absence of positive, rational thinking, the lack of normal socialization, a significant personal loss, as well as substantial stress over time can all drain the brain of the serotonin, dopamine, and norepinephrine that it needs to operate normally and properly. All of these issues need to be addressed in a comprehensive treatment plan.
Some persons who are depressed hesitate to take medicine or even go to a therapist, because they think medical or psychological intervention would be a sign of weak faith. They see medical intervention as incompatible with trust in Christ’s healing power. What would you say to such a person?
Do we blame a person with diabetes for taking his or her insulin? Of course not! In fact, it would be very unwise and irresponsible to NOT take the insulin regularly. For a person with endogenous (genetically-based) depression, their lack of serotonin and norepinephrine (and perhaps dopamine) is just as real a physiological deficit as is the diabetic’s lack of insulin.
As Christians, we have the treasures of the Word of God and the help and direction of the Holy Spirit with and within us, but we are made of the “same clay” as those who are not Christians. We are all “earthen vessels” (2 Cor. 4:7). We will in this life experience many of the same frustrations, heartaches, deficits and problems as other people. It’s how we respond over time (with God’s help) that can make such a big difference in life outcomes, short-term and long-term.
How can a pastor determine when a despondent church member needs medical or psychological referral?
If a pastor observes a person who is struggling mentally/emotionally for more than two weeks, and this is not the result of obvious, external life events, then he should immediately refer the despondent church member to a faith-affirming psychologist he trusts, who can do a thorough assessment and render a diagnosis. If the faith-affirming psychologist believes the church member is experiencing an imbalance in neurotransmitters, and thus, his or her ability to function normally is severely impaired, the faith-affirming psychologist can and should refer the church member to a psychiatrist he or she trusts.
Where does God’s Word fit into the process of counseling or therapy? What role does it have? When is “biblical” counsel most helpful or needed?
God’s Word and the power of the Holy Spirit can make a great, positive difference in the treatment plan! The biblical content can and should be included in the Cognitive Restructuring part of the therapy, and the Bible’s moral directives should inform whatever Behavioral Homework/Behavioral Contracting/ Accountability the counselor assigns. These forms of biblically-consistent psychotherapy often need to be combined with the best medical treatments, and regular exercise to be maximally effective. Multiple studies have also shown that worship experiences at church and positive socializing (authentic fellowship) often help significantly.
Fortunately, 85% of clients/patients respond positively to the best, standard, state-of-the art treatments outlined here. In the other 15% of the cases, the clients/patients and mental health care providers must be creative in finding long-term answers. Bottom-line: there are very good reasons to have hope when one experiences depression, or observes depression in a loved one.
After graduating from Wheaton College and Graduate School with degrees in Philosophy, Psychology, and Communication, Steve married Sharon in 1974. They have six children and eight grandchildren (so far!). Steve earned his PhD from the University of Minnesota in 1985.
He has served as the Director of the Psychology Department at Columbia International University, an accredited faith-based university in South Carolina. Steve has also taught as an Adjunct Professor at the University of South Carolina. He serves on statewide research-evaluation panels, and has received statewide awards for excellence in teaching and evaluation. He has served on the CIU faculty since 1995. From 1985-1995, Steve served as a Licensed Consulting Psychologist in Minnesota, and he helped manage two mental health clinics during that decade.
Steve has published three Kindle books:
*From Sigmund Freud to Viktor Frankl: How Psychiatry Became Human (2012)
*The Biblical Model of Human Psychology (2013)
*PSALMS That Can Change Your Life (2013)
Thank you, Steve, for these helpful definitions, distinctions, and insights. In future posts, some of the issues he covers in his answers will be addressed in more detail (for example, the role of God’s Word in addressing symptoms of depression).
Psalm 19:1-6 affirms that creation speaks of and glorifies God, the Creator. Under the banner of God’s Word as inerrant special revelation, insights gleaned from the study of humans through psychology, and the efficacy of medicines that are typically made from what God has created, offer what is called God’s “common grace” for the benefit of mankind.
“Now may the God of hope fill you with all joy and peace in believing, that you may abound in hope by the power of the Holy Spirit” (Rom. 15:13).